hort-term outcomes for both AVr-D and ARr-B-bio are excellent in patients with aortic root pathology. The long-term outcomes were associated with comparable survival and freedom from reoperation. AVr-D may be preferable to ARr-B-bio in patients with suitable pathoanatomy.Dystrophic aortic insufficiency accounts for the majority of Western cases of aortic insufficiency and can be divided into the three phenotypes of isolated aortic insufficiency, dilated aortic root, and dilated ascending aorta. https://www.selleckchem.com/products/U0126.html Each of these phenotypes is associated with a dilated annulus and/or sinotubular junction. Recent international guidelines recommend reimplantation or remodeling with aortic annuloplasty for valve-sparing root replacement, as well as consideration of aortic valve repair in cases of aortic insufficiency. A dilated aortic annulus is a major risk factor for failure of aortic valve repair procedures, indicating the need to address the annulus at the time of aortic valve or root repair. Calibrated annuloplasty should be performed at sub- and supravalular levels in order to restore the ratio of the sinotubular junction and annulus and be adapted according to the phenotype of the root and ascending aorta. Standardization of aortic valve repair techniques with use of a calibrated annuloplasty will improve dissemination of techniques and rate of aortic valve repair. Current medical evidence shows that aortic valve repair is safe, produces better quality of life, and reduces valve-related mortality compared to prosthetic valve replacement.Root remodeling is one form of valve-preserving root replacement to treat patients with aortic regurgitation (AR) and root aneurysm. We have consistently used it for patients with and without connective tissue disease and different aortic valve morphologies. The objective of this retrospective study was to review 23years of experience with root remodeling.
Between 10/95 and 9/2018, 1004 of 1038 root remodeling procedures were performed in patients with tricuspid (?=?589) or bicuspid (?=?414) anatomy of the aortic valve in our institution. Aortic aneurysm was present in 932 cases, 73 procedures were performed for acute aortic dissection type A. The severity of aortic regurgitation ranged from grade I to grade IV (mean 2.5?±?0.8).
All patients underwent root remodeling, concomitant operations were performed in 433, and cusp repair in 883 instances. Hospital mortality was 2%. Overall freedom from reoperation was 92% at 10years and 89% at 15years. It was 94% for tricuspid valves at 10 and 15years, and 88% for bicuspid aortic valves at 10years and 80% at 15years (?=?0.003).
In conclusion, root remodeling is a viable option in valve-preserving root replacement. If combined with careful assessment and, if necessary, correction of aortic valve form reproducible restoration of aortic valve function can be achieved.
In conclusion, root remodeling is a viable option in valve-preserving root replacement. If combined with careful assessment and, if necessary, correction of aortic valve form reproducible restoration of aortic valve function can be achieved.To analyze our long-term experience with valve-sparing reimplantation technique in treating aortic root aneurysm, aortic regurgitation, and aortic dissection in patients with tricuspid aortic valve.
Between March 1998 and October 2018, 303 consecutive patients underwent valve-sparing reimplantation in our institution. The mean age of this cohort was 52.9?±?15years. Time to event analysis was performed with the Kaplan-Meier method. Risk of death, reoperation, and aortic regurgitation (AR) recurrence were analyzed using the cox-regression method.
In-hospital mortality was 1% (?=?3) of which two were admitted for acute aortic dissection. Median follow-up was 5.81years ([IQR] 2.8-10years). Thirty-nine patients (14.4%) died during follow-up. At 5 and 10years, overall survival was 92?±?2%and 75?±?4.9%, respectively. Seventeen patients required late aortic valve reoperation. Freedom from valve reoperation was 95?±?2% and 90?±?3%. Freedom from AR?&gt;?2+ and AR?&gt;?1+ at 10years was 91?±?4% and 71.5?±?4.6%, ble, and reproducible, but further follow-up, well into the second decade is still necessary.
Aortic valve-sparing with the reimplantation technique has been performed for over two decades in our institution, and the results in patients with tricuspid aortic valve (TAV) are excellent in terms of survival and freedom from valve-related adverse outcomes including valve reoperation. These results continue supporting the use of valve sparing root replacement using the reimplantation technique (VSRR) in patients with aortic aneurysm, irrespective of whether they have preoperative AR or not. VSRR is safe, durable, and reproducible, but further follow-up, well into the second decade is still necessary.The aortic valve is the functional unit of cusp and root. Various geometrical and functional analyses for the aortic valve unit have been executed to understand normal valve configuration and improve aortic valve repair. Different concepts and procedures have then been proposed for reparative approach, and aortic valve repair is still not standardized like mitral valve repair. It has become apparent, however, that interpretation of the geometry of the aortic cusp and root and its appropriate application to operative strategy lead to creating a functioning aortic valve. Herein, the aortic valve geometry and its clinical implications are reviewed to provide information for the selection of appropriate operative strategies.Mitral regurgitation is common and is associated with excess morbidity and mortality. Despite these poor outcomes, only a minority of affected patients undergo mitral surgery, for several reasons, which underlines the substantial unmet need for treatment for this disorder. Transcatheter mitral valve repair interventions have been developed to treat mitral regurgitation in an undertreated patient population. The aim of this status quo review is to provide an overview of currently available transcatheter mitral valve repair techniques, the different approaches and the clinical outcomes reported so far.